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PubMed1996

[Otorhinolaryngological medical care by the general practitioners in rural areas].

In the present study, a survey of otorhinolaryngological medical care by the general practitioner, including the relationship between general practitioners and otorhinolaryngologists in rural areas was carried out. A questionnaire for otorhinolaryngological medical care by the general practitioners was sent to 326 hospitals with less than 100 beds where non-otorhinolaryngological doctors who had graduated from Jichi Medical School were working. Of these hospitals 164 (50.4%) responded. Most respondents said that they had about 3 or 4 patients with otorhinolaryngological disease per month. The distance between most hospitals and the nearest otorhinolaryngologists was within one hour by available transportation facilities. About 70% of the respondents were provided with simple otorhinolaryngological instruments, such as an aural speculum, a nasal speculum and a head mirror. The most frequent otorhinolaryngological diseases which they treated were vertigo, allergic rhinitis and upper respiratory infection including acute tonsillitis and pharyngolaryngitis. Only 10 to 20% of the general practitioners had otorhinolaryngological training. We found several problems in otorhinolaryngological medical care in rural areas. Patients with otorhinolaryngological disease seek otorhinolaryngological care at the nearest medical facility where general practitioners with inadequate otorhinolaryngological experience examine patients with inadequate otorhinolaryngological instruments. Therefore, a close relationship between general practitioners and otorhinolaryngologists should be developed and the quality of otorhinolaryngological medical care should be raised in rural areas.

Hospitals↗
PubMed1991

General practitioners' opinions of health services available to their patients.

OBJECTIVES: To establish a means for general practitioners to express their views about health services available to their patients, to identify services that general practitioners perceive as most in need of improvement, and to establish good working relations between the health authority's purchasing team and local general practitioners. DESIGN: Postal questionnaire survey of general practitioners. SETTING: Bristol and Weston health district. SUBJECTS: 226 general practitioners, of whom 171 replied. MAIN OUTCOME MEASURES: Scores of quality and quantity of hospital and community services, frequency that services were identified as priorities for improvement, and the nature of written comments received about services. RESULTS: There was considerable agreement among respondents about which services were adequate and which were inadequate. Most services were perceived as at least adequate in both quality and quantity, but seven services were perceived by more than 60% (102) of doctors as inadequate or worse in quantity and eight by 10% (17) of doctors as poor in quality. Orthopaedics, ophthalmology, care of elderly people, and physiotherapy were the services doctors most wanted improved. CONCLUSIONS: A postal questionnaire is an acceptable and accurate method of obtaining general practitioners' views about services available to their patients. General practitioners' priorities differ from those obtained from hospital medical advisory mechanisms.

Attitude of Health Personnel↗
PubMed1988

Are general practitioners ready to prevent the spread of HIV?

General practitioners are excellently placed to assess a person's risk of being infected with the human immunodeficiency virus (HIV) and to give advice on reducing that risk. Their attitudes to the acquired immune deficiency syndrome (AIDS) and infection with HIV are, however, unknown. A questionnaire survey of 196 general practitioners in East Berkshire Health District was used to assess general practitioners' readiness to undertake opportunistic health education to prevent the spread of infection with HIV. Altogether 132 replied. Sixty four of them expressed little interest in health education about HIV, and one in six would not dissent from the notion that AIDS could be controlled only by criminalising homosexuality. Only 75 of them had initiated discussions about HIV with patients. Moreover, many underestimated the risks from heterosexual sex while exaggerating the risks from non-sexual contact. Advice from general practitioners if given extensively might reduce the spread of infection with HIV. How best this may be achieved needs to be considered urgently.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Dramaturgical study of meetings between general practitioners and representatives of pharmaceutical companies; Commentary: dramaturgical model gives valuable insight.

OBJECTIVES: To examine the interaction between general practitioners and pharmaceutical company representatives. DESIGN: Qualitative study of 13 consecutive meetings between general practitioner and pharmaceutical representatives. A dramaturgical model was used to inform analysis of the transcribed verbal interactions. SETTING: Practice in south west England. PARTICIPANTS: 13 pharmaceutical company representatives and one general practitioner. RESULTS: The encounters were acted out in six scenes. Scene 1 was initiated by the pharmaceutical representative, who acknowledged the relative status of the two players. Scene 2 provided the opportunity for the representative to check the general practitioner's knowledge about the product. Scene 3 was used to propose clinical and cost benefits associated with the product. During scene 4, the general practitioner took centre stage and challenged aspects of this information. Scene 5 involved a recovery strategy as the representative fought to regain equilibrium. In the final scene, the representative tried to ensure future contacts. CONCLUSION: Encounters between general practitioners and pharmaceutical representatives follow a consistent format that is implicitly understood by each player. It is naive to suppose that pharmaceutical representatives are passive resources for drug information. General practitioners might benefit from someone who can provide unbiased information about prescribing in a manner that is supportive and sympathetic to the demands of practice. What is already known on this topic Pharmaceutical representatives influence physicians' prescribing in ways that are often unacknowledged by the physicians themselves Meetings with pharmaceutical representatives are associated with increased prescribing costs and less rational prescribing What this study adds Meetings between pharmaceutical representatives and general practitioners follow a consistent format that is implicitly understood by each player General practitioners may cooperate because representatives make them feel valued

Drug Industry↗
PubMed2001

[Expectations of established neurologists and general practitioners regarding the psychiatric clinic].

OBJECTIVE: Psychiatrists' and general practitioners' expectations regarding psychiatric hospitals were evaluated using qualitative methodology. DESIGN: A content analysis was carried out of interviews with 27 psychiatrists and 24 general practitioners. The statements were analysed quantitatively to assess their relative importance. RESULTS: Immediate delivery of discharge summaries and continuous patient-related communication were mentioned most frequently. In addition, psychiatrists assigned much importance to therapy referral after completion of inpatient care and to the prescription of less expensive drugs. Nearly half of all statements related to the communication process between local and clinic physicians, a quarter to aspects of referral, and a quarter to quality of inpatient care. Differences between psychiatrists and general practitioners mainly concerned aspects of medical education. CONCLUSION: Taking into account these findings, more attention should be paid to psychiatrists' and general practitioners' expectations to reduce problems of interaction between clinicians and their colleagues in private practice; this might be helpful to improve the continuity of psychiatric care.

Attitude of Health Personnel↗
PubMed1996

Attitudes of general practitioners to caring for people with learning disability.

BACKGROUND: The views of general practitioners on their increasing role in caring for people with learning disability in the community are not known. AIM: A study was carried out to assess the views of general practitioners with regard to providing routine care, organizing health promotion and specific health checks for people with learning disability and the role of specialists. METHOD: A postal questionnaire was sent to all 242 general practitioners in Gwent, south Wales. Participants had to mark their level of agreement with 20 attitude statements regarding learning disability. RESULTS: A total of 126 general practitioners (52%) responded. Respondents generally agreed that general practitioners were responsible for the medical care of people with learning disability. Respondents tended to be opposed to providing regular structured health promotion for people with learning disability, such as annual health checks and assessing hearing and eyesight. Specialist services were generally valued by respondents. CONCLUSION: General practitioners largely accepted their role as primary health care providers for people with learning disability. In contrast, their role as providers of health promotion for this patient group was not generally accepted. Further research into the appropriateness and opportunity costs of health screening for people with learning disability is needed.

Attitude of Health Personnel↗
PubMed1978

Demand for general practitioner and internist services.

Demand equations for general-practitioner and internist visits were estimated from 1970 CHAS-NORC survey data on health-service utilization and expenditure. Because a large proportion of respondents reported zero visits, observations were grouped according to cross-classified independent variables and regression analyses were performed using group means as data. The results showed significant differences between demand equations for general-practitioner visits and those for internist visits. Of potential importance was an apparent substitution of internists for general practitioners as ability to pay (income or insurance coverage) increased. Own-price elasticities were low for both general practitioners and internists but were even lower for the latter (0.1 to 0.02) than the former (0.2 to 0.3). The demand for services of the two specialties also differed with respect to disability days, age, sex, residence, and race.

Age Factors↗
PubMed1990

Handling of confidentiality in general practice: a survey among general practitioners in The Netherlands.

This paper describes the results of a study of the handling of confidentiality by general practitioners. A sample of 272 general practitioners in the eastern part of the Netherlands was interviewed. The general practitioners were presented with 10 cases involving confidentiality and were asked what course of action they would pursue. Twenty-eight per cent of the general practitioners would never disclose information to others without the patient's consent, while 14% would disclose information to other physicians, members of non-medical professions and relatives. The largest proportion (38%) would disclose information only to other physicians. General practitioners were less likely to divulge information if they were: younger, female or practising in group practices. In particular, general practitioners who involved patients in decision making were less likely to disclose information to third parties. A plea is made for more education about confidentiality in the medical curriculum.

Adult↗
PubMed1981

Medical manpower in South Australia with special reference to general practitioners.

A survey of general-practitioner and total medical manpower in South Australia has been made through the AMA local associations. This reveals that a sizeable increase in medical manpower, particularly for general practitioners, is likely in the coming decade. Immediate attention is warranted to find solutions to problems which can be expected to arise from a possible oversupply of doctors. The solutions will need to be acceptable to universities, governments, the AMA and the Australian people.

Australia↗
PubMed1999

Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study.

OBJECTIVE: To explore general practitioners' perceptions of their role in implementing genetic technology. DESIGN: Grounded theory interview study. SETTING: Primary care. SUBJECTS: Purposive sample of 30 general practitioners with a further theoretical sample of 14. RESULTS: Inconsistencies were identified between policy makers' and general practitioners' definitions of general practitioners' role in implementing the new genetics. General practitioners emphasised the need to build on current practice, whereas policy makers focused on transforming practice to include the new specialised roles and skills. Two core themes were identified: genetics in a generalist context, which included appropriate generalist intervention, the ethical dilemmas implicit in the "therapeutic gap," the familial-hereditary distinction in primary care, and the implications for generalist identity, including the potential marginalisation of generalism. CONCLUSION: New technologies such as genetics that require implementation in general practice should be integrated within existing generalist frameworks.

Ethics, Medical↗
PubMed2006

[General practitioners' and intensivists' relationships: intensivists' point of view from eight French southern regional areas].

OBJECTIVES: Assessment of relationship between general practitioners and intensivists. STUDY DESIGN: Intensivists were questioned by phone from June 14th to September 28th 2004. METHODS: 245 out of 264 intensivists from 8 French Southern regional areas were questioned concerning their relationship with critically ill patients' general practitioner. RESULTS: Patients were mainly admitted into Intensive care Unit (ICU) from the Emergency Department (55%). An information letter from the general practitioner was reported for 20% of admitted patients but 50% of these letters was assumed as not informative. The informations concerning the patient's medical history, therapies, and disease leading to admission and the patient's status were assessed with 6.5, 7.0, 6.0 and 2.0, respectively (maximal note=10). The intensivists contacted the general practitioner for 30% of admitted patients. During the stay in ICU, 33% general practitioners were reported to request informations by phone or visit in ICU. When the stay in ICU was>10 days, the general practitioner was nearly never regularly informed about patient's status. When the patient was discharged from the ICU, 80% of intensivists used an exhaustive typed report to inform the general practitioner. The overall relationship between the general practitioner and the intensivist was assessed as 5.5/10. Insufficient information in the general practitioner's letter at admission, the lack of request for information during the stay in ICU, the lack of contact with the general practitioner by the intensivist and an intensivist's age between 46 and 55 were associated with a relationship assessment<4/10).

Adult↗
PubMed1997

The case-conferencing project: a first step towards shared care between general practitioners and a mental health service.

OBJECTIVES: The objectives of this study were: (i) to improve general practitioners' knowledge of the mental disorders they commonly treat, and to increase their confidence in managing people with these disorders; and (ii) to increase general practitioners' familiarity with the Logan-Beaudesert Mental Health Service. METHOD: Eleven general practitioners met with psychiatrists from the Logan-Beaudesert Mental Health Service in six 2-hour sessions held at monthly intervals. Each session comprised a teaching component, a consumer interview and a case-conference. Outcomes were measured using an objective test of general practitioners' knowledge, a subjective test of their confidence in dealing with mental health problems, and satisfaction surveys for participating consumers, general practitioners and psychiatrists. RESULTS: On the objective test, the scores of 10 out of the 11 general practitioners improved (p < 0.05). On the subjective test, the ranked scores improved in nine out of the 11 cases (p < 0.05). Consumers, general practitioners and psychiatrists expressed their satisfaction with the format and content of the course. CONCLUSIONS: Having improved the knowledge of a group of general practitioners who are familiar with the functioning of the Logan-Beaudesert Mental Health Service, the stage is now set to proceed to the next step: the shared-care project.

Adolescent↗
PubMed1994

Impact of general practitioners' referral letters to an emergency department.

INTRODUCTION: We sought to determine the impact of general practitioner communication on the efficient management of patients who present to the emergency department. Casemix, severity, time of presentation, the quality of the letter and the reception of a telephone call were considered. METHOD: All consecutive patients presenting to the emergency department of Mornington Peninsula Hospital (Frankston) for one month in 1992 were included in this survey. The methodology is summarised in Figure 1. RESULTS: The referral letter made no difference to patients' waiting time and time spent in the department and a non significant difference in communication back to the general practitioner. This was found despite the quality of the referral letter, the time of presentation, and the diagnosis. The general practitioners' telephone call, however, decreased significantly the patient's waiting time. Investigations that were reported in the general practitioners' letters and not repeated by the emergency department resulted in a direct saving of $2604 for the month of the study. High interrater reliability was discovered in the rating of letters by six general practitioners. DISCUSSION: Despite the ability of general practitioners to select appropriate cases for referral, only the telephone call results in a quantifiable benefit for patients who attend their general practitioner. The high inter-rater reliability affirms the use of referral letters as audit tools in general practice. Better practical use could be made of general practitioners' referral communication to the emergency department.

Communication↗
PubMed1996

Stress among general practitioners and their spouses: a qualitative study.

BACKGROUND: Although research has been carried out on stress in general practitioners, little is known about the stresses experienced by their spouses. AIM: This study was undertaken to identify specific pressures at work and at home experienced by general practitioners and their spouses and to highlight their coping strategies. METHOD: In-depth interviews were conducted with 25 general practitioners and their spouses in the north-west of England. RESULTS: The doctors' increased workload and decreased interest in their family are important stressors for the entire family unit. Other stressors include time pressure, out-of-hours on-call, lack of support and amount of paperwork. General practitioners work late in the surgery, bring work home and spend time away from home at meetings. Family life is constantly interrupted by telephone calls. Role conflict was one of the major sources of stress for women general practitioners. Doctors' wives expressed concern regarding their husbands' excessive commitment to work and problems with communication. CONCLUSION: Recent changes to contractual working conditions have caused general practitioners to focus their energies on their practice instead of paying attention to the needs of their family. Male general practitioners leave the bulk of responsibility for running the family and household to their wives, but women general practitioners appear to maintain domestic responsibility while spending as much time in medical practice as their male colleagues. This is only an exploratory study based on a small sample, and so the findings cannot be generalized; however, it provides in-depth information on stress among general practitioners and their spouses.

Adaptation, Psychological↗
PubMed2005

Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial.

OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital dermatology clinic. DESIGN: Randomised controlled trial. SETTING: General practitioner with special interest dermatology service and hospital dermatology clinic. PARTICIPANTS: Adults referred to a hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. INTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care. MAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. RESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. CONCLUSIONS: The general practitioner with special interest service for dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.

Adolescent↗
PubMed1985

An economic approach to the daily activities of private general practitioners.

The present crisis in general medicine centres around the contents of the health-care services provided by general practitioners. These services were examined in a survey, carried out in 1975, of GP's daily activities. Collected data have been used to describe the characteristics of the daily activities of a typical general practitioner. Variations from this model have been interpreted in terms of three factors that characterize the local situation under which primary medical care is delivered: the nature of the health-care market, GPs' relationships with potential clients and their relationships with the local medical profession and environment.

Diagnosis↗
PubMed1988

Paediatric oncology information pack for general practitioners.

An information pack covering important aspects of paediatric oncology has been developed for general practitioners. Sixty general practitioners who received the information pack found that it helped them in managing children with neoplastic disease and their families. The pack has also improved communications between the oncology unit and general practitioners. Similar packs could be produced by paediatricians working in other specialties.

Child↗
PubMed1994

Predicting mental health problems in general practitioners.

A total of 704 general practitioners completed questionnaires enquiring about mental health problems (response rate = 82.0%). Excessive anxiety was reported by 31.1%, troublesome depression by 13.4%, exhaustion or stress (on three or more weekdays) by 60.7%, and sleep difficulties by 47.6%. General practitioners aged 40-49 years old were most likely to report anxiety, exhaustion or stress, sexual and sleep difficulties. Retired doctors reported mental health problems markedly less often. Predictive factors for anxiety were depression, one or more nights on-call per week, and exhaustion or stress; predictive factors for depression were anxiety, and exhaustion or stress; predictive factors for exhaustion or stress were anxiety, depression, no hobbies, paperwork on three or more evenings per week, and sleep difficulties. Gender, country of origin, being single-handed, excessive alcohol consumption, and having no coping methods were not predictive factors for mental health problems.

Adult↗